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CLASP > Radiology: Chest > Flashcards

Radiology: Chest Flashcards

(56 cards)

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1
Q

describe types of common emergency conditions seen on chest XR

A
  • misplaced nasogastric or endotracheal tube
  • misplaced central venous catheter
  • simple/tension pneumothorax
  • pleural effusion
  • lung/lobar collapse
  • lung consolidation
  • HF
  • foreign body
  • pneumoperitoneum (on erect XR)
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2
Q

what colour is air?

A

black

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3
Q

what colour is fat?

A

grey

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4
Q

what colour is soft tissue/muscle?

A
  • grey/white
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5
Q

what colour is bone?

A
  • white
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6
Q

what colour is metal?

A
  • bright white
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7
Q

ideal position for chest XR for a patient?

A

PA chest XR
- cardiothoracic ratio should be 0.5

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8
Q

how many ribs should you be able to see if CXR is adequately inspired?

A
  • at least 6 ribs visible
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9
Q

how do you know if a CXR is correctly centered?

A
  • medial ends of the clavicles should be equidistant from spinous processes of upper thoracic vertebrae
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10
Q

what can you visualise as mediastinal borders

A

along with
- aorta
- trachea
- hemidiaphragm
- stomach bubble in left hemidiaphragm
- horizontal fissure of right lung

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11
Q

what is the pulmonary hila?

A
  • hila are junctions between heart and lungs, where pulmonary arteries and bronchi enter and pulmonary veins exit the lungs
  • left hilum normally lies higher than the right
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12
Q

which diaphragm lies higher?

A
  • right side
  • should be able to visualise both from costophrenic angle to midline
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13
Q

common areas of missed findings?

A
  • lung apices - pancoast tumour, pneumothorax
  • behind the heart - consolidation, masses, hiatus hernia
  • below diaphram - free gas, lines and tubes e.g. nasogastric, gastric distension, bowel obstruction
  • bones and soft tissues - fractures, masses, mastectomy, sub emphysema, evidence of prev surgery
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14
Q

what parts of lung are adjacent to heart?

A
  • RML on right side
  • lingula of LUL on left side
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15
Q

why does lobar collapse occur?

A
  • obstruction of a lobar bronchus
  • due to tumours, aspirated food, mucus, impaction etc
  • as affected lobe loses volume it begins to collapse like a balloon deflating
  • the collapsed lobe’s density increases and adjacent major fissure is dragged out of position
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16
Q

what is a sail sign on chest XR?

A
  • suggests left lower lobe collapse
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17
Q

what do you see on left upper lobe collapse

A
  • when upper lobe collapses it collapses forward
  • makes heart look like it’s dissapeared
  • white density
  • less vol in left lung
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18
Q

what do you see right upper lobe collapse?

A
  • displacement of horizontal fissure
  • curvy line at top
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19
Q

does RML collapse more commonly alone or with RLL?

A
  • occurs with right lower lobe
  • profound loss of right hemidiaphragm and right heart border
  • density in right lower zone
  • occurs due to obstruction of both middle and lower lobe bronchi due to common origin at bronchus intermedius!
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20
Q

what do you see in a RML collapse?

A
  • loss of heart border
  • preservation of hemidiaphragm
  • density in right lower zone
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21
Q

what do you see in a RLL collapse?

A
  • loss of hemidiaphragm border
  • heart border preserved
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22
Q

pulmonary consolidation

A
  • less vol loss
  • similar to lobar collapse but lobe hasnt collapsed
  • can see air bronchogram
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23
Q

what is an air bronchogram?

Study These Flashcards
A
  • air-filled bronchi (dark) being made visible by the opacification of surrounding alveoli (grey/white)
  • usually caused by pathogenic airspace/alveolar process, in which something other than air fills the alveoli
  • if persist for weeks despite antimicrobial therapy -> suspicion of a neoplastic process
24
Q

describe this chest XR

Study These Flashcards
A

Dx: consolidation of lingular segment of left upper lobe

  • loss of left heart silhouette
  • blunting of costophrenic angle
  • consolidation seen in left upper lobe
25
what is the pleural cavity?
- the pleural space - space between parietal and visceral pleurae - it is a potential space only - contains only a few ml of fluid - thin layer of mucoid fluid lies between parietal and visceral pleurae for easy slippage of moving lungs
26
when is the pleural cavity visible on chest radiographs?
- when it is filled by fluid (pleural effusion) or air (pneumothorax)
27
what is seen on a chest XR with a pleural effusion?
- blunting of the costophrenic angles - as the pleural fluid collects at the lung bases formed the 'curved' appearance of a meniscus
28
what is a pneumothorax?
a pneumothorax follows rupture of the visceral pleura, allowing air to rush in from lungs every time the patient inspires - pleural air accumulates in this way, impairing resp function - a small pneumothorax is subtle
29
how can you spot a small pneumothorax?
- look for a dark crescent without lung markings bounded medially by the lung edge - often at the lung apex
30
complications of a tension pneumothorax?
- cardiac arrest - if the pneumothorax accumulates large amounts of air it will squash the lungs so patient cannot ventilate them thus it is a medical emergency and must be drained immediately
31
what will you see in a tension pneumothorax?
- mediastinal shift due to gas pushing lung into the contralateral hemithorax - diaphragm is pushed down - lower down than left
32
signs of heart failure
- elderly - multiple MI's - IHD - valvular HD - hypertension - arrhythmias (AFib) - breathlessness worsened by exertion - cough - frothy white/pink sputum - orthopnoea - using multiple pillows to sleep at night - peripheral oedema - paroxysmal nocturnal dyspnoea (suddenly waking up during the night SOB)
33
what will you see in a heart failure patient on chest XR
radiological signs of pulmonary oedema in order of severity 1. dilatation of upper lobe vessels/cardiomegaly (v white chest XR) 2. interstitial opacities - peribronchovascular cuffing - septal lines (kerley B lines) 3. airspace opacification - filing of alveoli w fluid - when severe and acute - perihilar or batwing distribution - air bronchograms - air filled bronchi running through fluid filled alveoli
34
what is this?
- Kerley B lines
35
mnemonic for heart failure?
A - alveolar oedema (bat wing opacities) B - Kerley B lines C - cardiomegaly D - dilated upper lobe vessels E - pleural Effusion
36
where should the endotracheal tube sit?
- tip 5cm above carine - cuff should not expand the trachea
37
how should a NG tube be positioned?
- go into nostril - over back of nasopharynx - pass through oesophagus - and enter stomach - tip should be in stomach (subdiaphragmatic position)
38
what are some common malposition's of NG tube?
- remaining in oesophagus - transversing either bronchus or more distally into the lung - coiled in upper airway - intracranial insertion i.e. enter skull
39
most common entry point for a central venous catheter and why?
- right internal jugular - it is straightest line to the SVC -> other options are left internal jugular or left and rght subclavian veins - all tip lines should be the same... junction of the SVC and right atrium - peripherally inserted central catheters (PICC) are inserted via cephalic, basilic, or brachial veins
40
where is an appropriate location for a central venous catheter?
- tip is somewhere around anterior end of right 2nd rib - (cavoatrial junction)
41
what is some potential malposition's of a central venous cather?
tip too high - proximal SVC - increased risk of thrombus formation tip too low - distal right atrium or right ventricle - inc risk of arrythmia coiled and displaced in another vein
42
where will you find mets in the lung?
- more often at the bases
43
pulmonary mass in right upper zone? new, haemopytsis
- lung cancer - often associated lobar collapse in lung cancer. so if patient is not septic highly suspicious for cancer
44
pulmonary mass in right lower zone? about to start tx for RA
- benign hamartoma
45
what imaging is used for standard staging for a lung cancer?
- contrast enhanced CT allows you to assess tumour size mets - nodal, lung, liver, adrenal, skeletal guiding a biopsy of peripheral lesions - FDG-PET CT metabolic test nodal mets distant mets
46
what is a pneumoperitoneum?
- perforation of a hollow viscus (stomach, duodenum, small or large bowel) results in gas in peritoneal cavity
47
what will you see on chest XR of a pneumoperitoneum
- radiograph taken with patient in erect position allows gas to rise up under diaphragm therefore you will see a thin black line between diaphragm and sub diaphragmatic structures
48
presentation of a PE
- dyspnoea either at rest or at exertion - pleuritic chest pain, cough, orthnopnoea and haemoptysis - causes: DVT, calf/thigh pain and swelling may occur
49
what is gold standard to look for a PE?
- CTAP CT pulmonary angiogram to look for clot - injecting dye into upper limb - V/Q scan perfusion scan to look for defects caused by clots but not very appropriate. But is used in pregnant women.
50
60 yr old women, weight loss, cough >6 weeks, haemoptysis finger clubbing 20 pack year smoking hx Ddx?
- lung cancer - TB - exacerbation of COPD - not sepsis as normal sats and BP
51
suspected lung cancer. what do we do next?
- urgent CT scan (w contrast) and resp referral
52
why do smokers get big black areas in lung?
- emphysema
53
what is bronchiectasis
- dilatation of a bronchus and has to be bigger than vessel it sits next to
54
patient w lung cancer what other organs are you wanting to focus on?
- liver for mets - brain for mets - adrenal for mets - bone - skeletal - lymph nodes - left hilum, and supraclavicular and internal mammary
55
trauma setting: you want to know about blood or strokes what scan?
- non contrast CT scan
56
when you want to know about brain mets what scans?
non contrast and contrasted CT scans

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